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Manual handling and low back pain at work
Low back pain is the commonest cause of absence from work, and most of it is non-specific and improves – so look for red flags, avoid imaging and bed rest, encourage activity and early return to work, and prevent it at work by designing the task rather than only by training people "how to lift correctly".
Why it matters in the exam
Items on this topic describe a warehouse worker, a nurse or a driver with acute back pain and ask for the next step: without red flags there is no need for imaging in the first weeks, staying active is advised and return to work is encouraged as early as possible, with adjustments if needed. Other items ask what predicts chronicity – "yellow flags" such as fear of movement, the belief that pain is dangerous, depression and job dissatisfaction – more than imaging findings. In ergonomics the NIOSH lifting equation is tested: the recommended weight limit starts from a constant of 23 kg multiplied by factors for horizontal distance from the body, height, travel distance, twisting, lifting frequency and grip quality; the lifting index is the actual weight divided by the recommended limit, and a value above 1 indicates increased risk. Effective preventive measures are engineering and organizational – mechanical aids, lighter loads, keeping the load close to the body and lower frequency – whereas lifting-technique training alone and back belts have not been shown to work. In hospitals a "safe patient handling" policy with hoists is recommended for transferring patients.
Key points
- Most back pain at work is non-specific and improves.
- Without red flags there is no need for imaging in the first weeks.
- Activity and early return to work are better than rest.
- Yellow flags predict chronicity.
- In the NIOSH equation a lifting index above 1 indicates risk, and the main prevention is changing the task.
Summary table
| Topic | Principle | Exam point |
|---|---|---|
| Red flags | Fever, weight loss, history of cancer, significant trauma, progressive weakness, loss of sphincter control | Require urgent work-up and imaging |
| Non-specific pain | Stay active, simple analgesics, early return to work | Bed rest prolongs recovery |
| Yellow flags | Fear of movement, catastrophizing, depression, job dissatisfaction | Predict chronicity and long absence |
| NIOSH lifting equation | A constant of 23 kg times factors for distance, height, twisting, frequency and grip | A lifting index above 1 – increased risk |
| Workplace prevention | Mechanical aids, lighter loads, load close to the body, less twisting | Technique training alone is not enough |
| Patient transfer | Hoists and a safe-handling policy | Reduces back injuries in staff |
A free exam question
בן 30 ,עם כאב גב מותני, הקורן לגף התחתון SLR חיובי, בבדיקה הנ וירולוגית חולשה רפה בפשיטה (אקסטנציה) של הבוהן הגדולה, חולשה חלקית באבדוקציה של הירך, חסר תחושתי מעל ראש ה- Metatarsus .השני בוצעה בדיקת MRI .לעמוד שדרה מותני איזה ממצא מבין הממצאים הבאים בבדיקת הדימות יכול להסביר את הסימנים שנתגלו בבדיקה? (the question as examined, in Hebrew)
- א. בקע דיסק פוסטר( ולטרלי Posterolateral ) בגובה L4/5 עם לחץ על שורש הע צב בגובה הדיסק הבין- .חולייתי
- ב. ( בקע דיסק פורמינלי Foraminal ) בגובה L4/5 עם לחץ על שורש העצב .בפורמינה
- ג. ( בקע דיסק פוסטרולטרלי Posterolateral ) בגובה L3/L4 עם לחץ על שורש העצב בגובה הדיסק הבין חולייתי
- ד. בק( ע דיסק פורמינלי Foraminal ) בגובה L3/4 .עם לחץ על שורש העצב בפורמינה
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Sources
- NIOSH, Applications Manual for the Revised NIOSH Lifting Equation, 1994, revised 2021 — Recommended weight limit and lifting index
- NICE, Low back pain and sciatica in over 16s: assessment and management (NG59), 2016, updated 2020 — Assessment, imaging and non-invasive treatment
- Waddell & Burton, Occupational health guidelines for the management of low back pain at work, 2001 — Occupational Medicine – evidence review
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.